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Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for children, adolescents, and young
Andrea Hayes-Jordan1, Holly Green, Heather Lin
1Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA, ahjordan@mdanderson.org.
Insights
Pediatric hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery offers a unique treatment for extensive peritoneal disease. Complete cytoreduction is crucial for improving patient outcomes and survival rates in young patients.
Area of Science:
- Pediatric oncology
- Surgical oncology
- Chemotherapy
Background:
- Extensive peritoneal metastatic disease is rare in children, with sarcomatosis being more common than carcinomatosis.
- A pediatric hyperthermic intraperitoneal chemotherapy (HIPEC) program was initiated to address this rare condition.
- This report details the initial outcomes of the first 50 pediatric, adolescent, and young adult patients treated.
Purpose of the Study:
- To evaluate the initial results of a pediatric hyperthermic intraperitoneal chemotherapy (HIPEC) program.
- To assess the safety and efficacy of cytoreductive surgery combined with HIPEC in young patients.
- To identify factors influencing outcomes in pediatric patients with extensive peritoneal disease.
Main Methods:
- A single-institution, retrospective study of 50 patients aged 3-21 years undergoing cytoreductive surgery and HIPEC.
- HIPEC was administered as an adjunct to standard chemotherapy and radiotherapy.
- Data collected included demographics, treatment outcomes, and complications.
Main Results:
- The most frequent diagnoses were desmoplastic small round cell tumor, rhabdomyosarcoma, and mesothelioma.
- Complete cytoreduction was significantly associated with a lower risk of recurrence and improved overall survival (OS).
- Patients with a higher peritoneal cancer index (PCI) had a shorter median OS compared to those with a lower PCI.
Conclusions:
- Cytoreductive surgery and HIPEC represent a unique, programmatic approach for pediatric patients with extensive peritoneal disease.
- Optimal outcomes were observed in patients with desmoplastic small round cell tumor and those achieving complete cytoreduction.
- Complete cytoreduction in the absence of extra-abdominal disease is critical for maximizing patient survival.
Background:
Extensive peritoneal metastatic disease is rare in children. Although usually manifested as carcinomatosis in adults, sarcomatosis is more common in children. The authors began a pediatric hyperthermic intraperitoneal chemotherapy (HIPEC) program, and this report describes their initial results from the first 50 pediatric, adolescent, and young adult patients.
Methods:
A single-institution, retrospective study investigated the first 50 cytoreductive surgeries and HIPEC by one surgeon for patients 3-21 years of age. The HIPEC was added to chemotherapy and radiotherapy treatment. Demographics, outcome, and complications were recorded.
Results:
The median follow-up period for the surviving patients was 21.9 months. The most common diagnoses were desmoplastic small round cell tumor (n = 21), rhabdomyosarcoma (n = 7), mesothelioma (n = 4), and other carcinoma (n = 17). Multivariate analysis showed that patients treated with HIPEC and an incomplete cytoreduction had a greater risk for recurrence than those who had a complete cytoreduction (p = 0.0002). The patients with a higher peritoneal cancer index (PCI) (i.e., a large tumor burden) had a median overall survival (OS) time of 19.9 months relative to the patients with a lower PCI score, who had a median OS of 34 months (p = 0.049). The patients without complete cytoreduction had a median OS of 7.1 months compared with 31.4 months for the patients with complete cytoreduction (p = 0.012). No perioperative mortalities occurred. The incidence of major complications was 28 %.
Conclusion:
Cytoreductive surgery and HIPEC with a programmatic approach for patients 3-21 years of age is unique. The best outcome was experienced by patients with desmoplastic small round cell tumor and those with complete cytoreduction. Complete cytoreduction for patients without disease outside the abdominal cavity at the time of surgery affords the best outcome.
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